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Timothy Reynolds
(magrenell)

Locale: New England
Achilles Tendon on 10/12/2009 11:39:31 MDT Print View

Hi, Y'All;

Two weeks ago, I did some damage to my Achilles Tendon while out for 5 days. At the time, I walked through it, and the problem seemed to disappear when I got home. This last Friday, I put on my boots again for the first time since this trip (I was about to go on a day hike) and the problem immediately flared up -- worse than before. I simply couldn't go out in this condition.

I've a weekend trip planned in two weeks. Do any of you have advice as to what I can do to take care of myself, and get my leg back into shape?

As i intimated earlier, my heel/back of leg doesnt' hurt when I've got regular shoes or sneakers on. So walking around normally isn't an issue.

Thanks.

Chris W
(simplespirit) - MLife

Locale: WNC
Re: Achilles Tendon on 10/12/2009 11:41:46 MDT Print View

Try hiking in your sneakers.

jim draucker
(mtnjim) - MLife

Locale: Shenandoah Valley VA
tendon on 10/12/2009 11:48:02 MDT Print View

Hello

Damage? These things don't heal quickly. I had my left one severed / rupture a few years ago. In hindsight I was dehydrated and not properly warmed up before injury. Sounds like your body is sending you a message.Proceed with caution. Have you had it looked at?

Jim

Timothy Reynolds
(magrenell)

Locale: New England
Re: Achilles Tendon on 10/12/2009 12:17:20 MDT Print View

I haven't had it looked at, as it's not bothering me at all when I'm just walking around doing ordinary stuff. Because the problem flared up after putting on my boots (the ankle support part seems to aggravate the situation), I thought that perhaps it's not so serious. If it's still doing the same thing by the end of the week I'll go to the doctor.

I was just wondering if anybody and any kind advice as to resting it or rehabilitating it. Just a thought.

Thanks.

David Olsen
(oware)

Locale: Steptoe Butte
TENDON on 10/12/2009 12:28:56 MDT Print View

You need to keep all pressure off the tendon.
Some times just putting in a heel lift (IE) piece
of foam, will stop the pressure exerted on that spot.
You may just have to wait till the boots are better
broken in, or you may just have to throw them away and
use something else.

Sometimes its just better to kick back and have a beverage
till those things heal.

Otherwise it may be months till
it gets better.

jim draucker
(mtnjim) - MLife

Locale: Shenandoah Valley VA
Tendon on 10/12/2009 12:35:17 MDT Print View

I'm no doctor and I don't play one on TV. Time for the repair to knit, alot of physical therepy. I actually added
beef tendon to my diet during this time.Interesting part is that mine did not hurt until aftyer surgery? My foot would not work but pain was minimal until repair was made.I walked this way for a full week.Down time is the key.

Jim

Edited by mtnjim on 10/12/2009 12:37:54 MDT.

Hart -
(backpackerchick) - MLife

Locale: Planet Earth
Achilles Tendonitis on 10/12/2009 16:10:22 MDT Print View

(Disclosure: I have a medical degree -- I am not currently practicing. I am going to take a different path. I don't claim to be an expert on this matter. So this is not "medical advice" per se.)

The difference probably has to do with the amount of heel lift in the various shoes. The angles are not always obvious just looking at the shoe. Boot also could be exerting pressure where the tendon inserts on the bone.

I had Achilles tendonitis at one point. The doctor, a real Texan told me 3 weeks in a walking cast (in which the heel would be lifted, of course) or 3 weeks in cowboy boots. My understanding is that raising the heel a bit, takes some of the tension off the tendon.

If it hurts, don't do it. Be thankful that you have some shoes that don't hurt. Such inflammation can really drag on. Stay out of the boots that hurt! You may have some luck wrapping a single piece of tape around the ankle about two inches above the malleoli (the prominences on either side of the ankle). Could make it feel worse -- then don't do it.

I am assuming this is an overuse/unaccustomed activity type injury -- not sudden pop? If there was a sudden pop and "give", you need an ortho consult and an mri. should repair be necessary, it is much more successful when done sooner rather than later. My personal philosophy these days is NOT to see an orthopedic surgeon unless I am considering an operation or feel something go or break. MRI is a very sensitive test -- if you've got a sore tendon, the MRI IS going to show inflammation. So what. You get a bill and some Aleve and some exercises that you could have looked up on the internet. If you have a great health plan, and you got an afternoon to wait around, I suppose why not.

Judicious use of NSAID (Aleve, ibuprofen, etc -- if they don't seem to help, stop taking them -- not worth the risk to the kidney if you aren't getting benefit), ice/heat combos, stretch after heat -- most people can stretch their Achilles by standing with the heel hanging off a stair -- you can bend the knee ever so slightly to see if this increases the stretch. If you are too flexible to get much of a stretch from this, let me know as I have some other ideas. DO NOT attempt to strengthen the calf with heel raises -- this will only fuel the fire. Maybe after things settle down.

Some doctors will give a hydrocortisone shot for this but there is often hesitation to inject the Achilles so that you can go run around on it. There is some risk of weakening the tendon and making it more vulnerable.

If you have taken a fluoroqunilone antibiotic (they end in -floxacin) in recent months, see a doctor immediately. These drugs have FDA black boxes re: Achilles tendonitis/rupture as they weaken the attachment of the tendon.

Edited by backpackerchick on 10/12/2009 17:44:02 MDT.

Ryan Tucker
(BeartoothTucker) - M
not a doctor on 10/12/2009 17:39:22 MDT Print View

in college i hurt my AT and part of my rehab was sitting in my dorm using my toes to pull a towel toward my foot with my heal on the ground. a little AT rehab might help. probably could goggle more exercises. i did several, that one just sticks out.

Hart -
(backpackerchick) - MLife

Locale: Planet Earth
Re: not a doctor on 10/12/2009 17:53:36 MDT Print View

Ryan, the one you mention might be the best one to start with especially if you're really tender as it doesn't involve weight bearing and the possibility of over stretching. All these are classic exercises for a very common problem. Should have no trouble googling a whole slew of stretches and finding one that feels good to you. Try youtube as well. There are some good physical therapy videos -- just search...achilles physical therapy

Roger Caffin
(rcaffin) - BPL Staff - MLife

Locale: Wollemi & Kosciusko NPs, Europe
Re: Re: Achilles Tendon on 10/12/2009 17:56:49 MDT Print View

> problem flared up after putting on my boots (the ankle support part seems to aggravate the situation)
Possibilities:
Snapped tendon (had that)
Torn tendon (had that)
Ruptured tendom sheath (had that)
Bruising (had that)

The clue is that rubbing the tendon with the 'ankle support' part of the boot caused the problem to flare up again. This spells a ruptured tendon sheath to me. It's a form of repetitive strain injury (RSI), and can be quite serious and incapacitating. It's also well-known.

But the cure is simple. Don't let anything rub the tendon. Scrap the boots and walk in low-cut joggers. No rubbing, no problem - and you have already verified that at home. Most experienced BPL members walk in joggers anyhow, and probably don't even own any boots.

Cheers

Hikin' Jim
(hikin_jim) - MLife

Locale: Los Angeles, CA, USA
Ouch! on 10/12/2009 23:12:25 MDT Print View

The Achilles is serious business. Tend to it (sound like you are). I was sidelined for three years (2002 - 2004) with tendinitis. Very little hiking and NO backpacking. Augh!

I found that pressure point massage/trigger release body work worked for me. Yours sounds different, but that's something to look into if other things don't work.

Best of wishes to your AT,

HJ

Timothy Reynolds
(magrenell)

Locale: New England
Thanks! on 10/13/2009 10:29:11 MDT Print View

Thanks so much, everyone, for your insight.

Thanks, Backpacker Chick, for going into such detail.

The injury, I'd say, was caused by my boots. They're newish, and this was the first time I'd put them to a real, long-hike test. We were consistently hiking up and down peaks, doing 3500ft each way regularly; sometimes three peaks a day. The pain manifested on my last day, and my first thought was that my heel was slipping up and down too much; that this was/is a repetitive bruising injury.

The exercises, and hot/cold/stretch therapy suggested are all being put into action. But what I'm a little unclear about is should, or should I not, put a heel lift in my left boot to prevent this from happening again? I don't like to use joggers as they cause a lot of foot/sole pain for me.

All the best,

Tim.

Adrian B
(adrianb) - MLife

Locale: Auckland, New Zealand
Re: Thanks! on 10/19/2009 14:02:29 MDT Print View

I injured my achilles about 16 months ago running, then made it worse by hiking on it (badly enough that I could barely walk).

I don't want to discourage you, but in my experience the various heel lifts, stretches, ultrasound, icing, massages, stretches and exercises all did nothing. Many of these treatments are entirely unscientific (sadly, like a lot of physical therapy), except for perhaps the eccentric exercises (calf raises with increasing weights) which I think has some empirical evidence. Some claim that heel lifts in shoes can shorten your tendon.

When getting back into hiking I found shoes with shanks/stiff soles would tire it out and cause pain, perhaps because they tended to act as a lever, pushing more work onto my tendon. More flexible slipper-like shoes were better. I would strongly reconsider your preference for boots over runners, your soles will quickly get used to them, and the health of your tendon is the crucial thing.

The entire episode has pushed me further away from any sort of rigid or built up shoes/boots at all. I suspect the original injury was caused or at least aggravated by the thick cushioned heel of my running shoes, which some have suggested can damage the tendon my allowing it to stretch out under load as it sinks into the foam. Christopher McDougall's book 'Born To Run' was also an eye opener.

I've been back to full hiking mileage for the last 10+ months, running I still have to take it easy (that perhaps is true of most people though). At the time I had no idea that it would take 6 months to heal though, I thought it was just another twinge/ache that I could walk off like the rest.

Edited by adrianb on 10/19/2009 14:11:27 MDT.

Adrian B
(adrianb) - MLife

Locale: Auckland, New Zealand
Re: Re: Thanks! on 10/19/2009 14:07:19 MDT Print View

Just an addendum - with tendons you really have to reset your expectations around healing time. Two weeks since you noticed the pain on your 5 day trip is really no time at all.

If you're feeling pain walking, you really should consider cancelling your upcoming trip, and build up with shorted periods of walking that you can do without pain. It might seem drastic, but you really don't want to have to take an entire six months off (trust me).

Adrian B
(adrianb) - MLife

Locale: Auckland, New Zealand
Re: Achilles Tendonitis on 10/19/2009 14:16:20 MDT Print View

>Judicious use of NSAID (Aleve, ibuprofen, etc -- if they don't seem to help, stop taking them -- not worth the risk to the kidney if you aren't getting benefit)

I'd really suggest avoiding painkillers, you really don't want to mask the pain and end up walking when you shouldn't and causing more damage. Which is easy enough to do even as it is.

Roger Caffin
(rcaffin) - BPL Staff - MLife

Locale: Wollemi & Kosciusko NPs, Europe
Re: Re: Achilles Tendonitis on 10/19/2009 18:15:09 MDT Print View

> I'd really suggest avoiding painkillers, you really don't want to mask the pain and end up
> walking when you shouldn't and causing more damage. Which is easy enough to do even as it is.

ABSOLUTELY RIGHT!

Cheers

Robert Mak
(blmac) - F
my experience on 07/28/2010 20:04:35 MDT Print View

I injured my achilles when section hiking the AT in vermont. This was caused mostly by a new pair of runners I bought half way through the trip. The heel cup rubbed against my heel in a manner my foot did not agree with. I could not walk with those shoes acute pain would shoot up my achilles. It went "away" when I changed shoes again at the next town. Though I could now walk the underlying condition remained though it wasn't being irritated with the new shoes.

It sounds like you have tendonitis. If you check your achilles it is probably inflammed. Conventional physiotherapy treatment is stretching and anti inflammatory pills. I found stretching did nothing to heal the condition. I did not try the pills. This condition can last a long a time (months) if you don't do something actively to heal it and just try to wait it out.

I found massaging the area between the bottom of the calf and the top of the achilles to relieve a significant amount of pain. Lay your calf over the other knee and knead it. It will be painful and tender but in a relieving kind of way. Do this for a minute or so a few times a day. According to a physio report I read, the best way to heal tendonitis is to do eccentric exercises. You stand on your tippytoes at the edge of a stair runner (with you facing upstairs). Then lower yourself down so your heels go over the edge. You can rehabilitate your achilles like this after a relatively short while. This technique cured the lingering pain that the massage did not take care of for me.

Some people also cut the tops off of the heel tab on runners to specifically avoid/alleviate this problem.

Don't ever wear those boots again find something else. That particular pair does not agree with your foot. The boot will break your feet not the other way around.

Edited by blmac on 09/07/2010 16:04:20 MDT.

John Huth
(apacherunner) - F

Locale: New England
Thanks! on 08/08/2010 16:19:05 MDT Print View

I'm new to the list, but benefitted from this thread!!

I'd gotten a flare-up of AT in January while racing an 800m indoors. It's been on and off and I had a backpacking trip facing me when I absolutely wanted to go, and didn't want to damage my tendon more. I stumbled on this thread and the advice was spot on.

Here's what I did:

Stay very hydrated - I drank every chance I got

Take NSAID's in the evening, but not on the trail

Walk on my heels more - I found I had to "sit" more while walking, so I didn't engage my calf muscles so much. I think this one was the key.

Massage the trigger point in my calf as often as I could - during rest stops, at night etc.

Reduce the daily mileage - fortunately I had this flexibility

I came out of it fine - it was a bit sore after the trip, but I enjoyed it greatly.

FWIW - I was in the Wenaha Wilderness in SE Washington State - a great place - especially on the high ridges.

Piper S.
(sbhikes) - F

Locale: Santa Barbara (Name: Diane)
Re: Achilles Tendon on 08/09/2010 11:59:18 MDT Print View

Where on your achilles tendon? I hurt mine last year but it hurts very low on my heel a little to the outside edge. The pain is still there after more than a year. I have worn very simple, flat, flexible shoes and sandals all year long since then. The pain always comes back after a long walk whether there are hills or flats. I don't know how to resolve the problem, although to be honest I haven't really tried anything other than not pushing hard up steep hills and basically taking it easier than usual. Thing is, sometimes walking the flats around town flares up the pain worse than a nice vigorous hike. I figure I just have to live with it. The pain does go away after I walk around and loosen things up again. I think my feet are basically ruined for life and I think it's been so long now since the original injury that there's probably no hope to heal from it.

Ben Crowell
(bcrowell) - F

Locale: Southern California
Re: Re: Achilles Tendon on 08/09/2010 12:57:52 MDT Print View

Sorry to hear about your health problems, Piper. A year is actually not very long for an injury to connective tissues in your extremities. They don't get very much blood flow, and they just heal extremely slowly. I got shin splints ca. 1985, which took about 5 years to heal, but they've been fine ever since. I got plantar fasciitis ca. 2003, which also took about 5 years to heal, but now appears to be 100% gone.

Laypeople, doctors, and physical therapists will all have a tendency to suggest treatments for this kind of stuff that have not been shown scientifically to be effective, or even treatments that have been shown scientifically *not* to be effective. That means it's up to you to find out what is really supported by research.